Disciplines and their support to mitigate PICC harm
| Discipline | Mitigate PICC harm |
| Vascular access team | Advise and recommend optimal device choice per patient; preferential single-lumen PICC to reduce complication risk; ensure proper insertion and maintenance; evaluate quality processes related to line care (eg, dressing intactness, occlusion rates, phlebitis, infections, thrombosis; line de-escalation). |
| Nursing | Play a key role in the choice of peripheral access device and line care. |
| Bedside nurses | Establish competencies for placing peripheral venous catheters; adhere to the standard of intravenous line care to reduce occlusion risk (eg, avoid drawing blood from lines) and prevent infectious complications; evaluate the continued PICC need and risk; train when to escalate to the vascular access team for expertise. |
| Infection preventionists | Provide feedback on central line use and infectious complications; participate in development of policies and new product reviews. |
| Pharmacists | Evaluate switch to oral medications; address the use of alteplase as a marker for occlusion; advise on vesicant and irritant infusions. |
| Physicians | Play a key role in requesting PICC line placement and also its duration of use. |
| Infectious diseases | Assess the need for long-term parenteral antimicrobials versus potential oral alternatives; promote optimal device choice and discontinuation of PICC when no longer needed. |
| Surgery | Assess the need for parenteral versus enteral nutrition; evaluate the optimal short-term central line to use. |
| Hospitalists/internists | Care for a large number of patients; avoid ordering PICCs out of convenience (eg, for blood draws); understand the appropriate indications for use; daily evaluate device for complication risk and necessity. |
| Intensivists | Choose the optimal line and place central venous catheters; daily evaluate device for complication risk and necessity; further evaluate the need for central access when ready to transfer out of intensive care. |
| Physicians in training | Evaluate on the indications for vascular device use, place central venous catheters and address discontinuation; address their competencies for placing and maintaining catheters; closely partner with bedside nurses on device necessity and risk. |
| Nephrologists | Champion the importance of avoiding PICC placement in patients with chronic kidney disease to reserve venous access. |
| Interventional radiologists | Partner with the vascular access team on patient selection for PICC (preferably the vascular team performs the procedures preventing patient exposure to fluoroscopy); obtain reason for PICC placement; use single-lumen PICC unless otherwise requested. |
| Administrative leaders | Provide support for an effective vascular access team; understand the adverse quality outcomes (eg, patient experience, deep venous thrombosis, infection) and financial risks (eg, hospital-acquired condition penalties) without an effective vascular access team. |
PICC, peripherally inserted central venous catheter.